A neurosensory hypothesis of ligament function.

Ligaments are generally viewed as passive structural elements. Virtually all treatments for torn ligaments are based upon a structural paradigm. However, there is considerable evidence to suggest that ligaments function as neural sensors to facilitate supportive reflex contractions of muscles. It is hypothesized that injury to ligaments disrupts the neural apparatus as well as the structural support. Dysfunction following injury may result as much from neural injury as from structural instability. In some patients, "neural adaptation" likely occurs, while in others it does not. Since current treatments for ligament injuries (all of which are based on structure) are not uniformly successful, we need to develop methods to distinguish the neurally impaired patient from the structurally impaired, and to develop methods to treat the former.